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Komolafe TE, Zhou L, Zhao W, Guo J, Li Z, Fan Z, Komolafe BF, Wei W, Samuel OW. Advancing robot-guided techniques in lumbar spine surgery: a systematic review and meta-analysis. Expert Rev Med Devices 2024:1-15. [PMID: 39007890 DOI: 10.1080/17434440.2024.2378080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/04/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Lumbar spine surgery is a crucial intervention for addressing spinal injuries or conditions affecting the spine, often involving lumbar fusion through pedicle screw (PS) insertion. The precision of PS placement is pivotal in orthopedic surgery. This systematic review compares the accuracy of robot-guided (RG) surgery with free-hand fluoroscopy-guided (FFG), free-hand without fluoroscopy-guided (FHG), and computed tomography image-guided (CTG) techniques for PS insertion. METHODS A systematic search of various databases from 1 January 2013 to 30 December 2023 was conducted following PRISMA guidelines. Primary outcomes, including PS insertion accuracy and breach rate, were analyzed using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS The overall accuracy of PS insertion using RG, based on 37 studies involving 3,837 patients and 22,117 PS, is 97.9%, with a breach rate of 0.021. RG demonstrated superior accuracy compared to FHG and CTG, with breach rates of 3.4 and 0.015 respectively for RG versus FHG, and 3.8 and 0.026 for RG versus CTG. Additionally, RG was associated with reduced mean estimated blood loss compared to CTG, indicating improved safety. CONCLUSIONS The RG is associated with enhanced accuracy of PS insertion and reduced breach rates over other methods. However, additional randomized controlled trials comparing these modalities are needed for further validation. PROSPERO REGISTRATION CRD42023483997.
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Affiliation(s)
| | - Liang Zhou
- Department of Radiology, Jiading District Central Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
- Biomedical Engineering Fusion Laboratory, Jiangning Hospital Affiliated with Nanjing Medical University, Nanjing, China
| | - Wenlong Zhao
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jiachen Guo
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zongdao Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhiping Fan
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Blessing Funmi Komolafe
- School of International Education, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wang Wei
- Department of Orthopaedic, School of Medicine, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
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Guan J, Feng N, Yu X, Yang K. Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies. Syst Rev 2024; 13:170. [PMID: 38970142 PMCID: PMC11227242 DOI: 10.1186/s13643-024-02600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 06/30/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND As an emerging technology in robot-assisted (RA) surgery, the potential benefits of its application in transforaminal lumbar interbody fusion (TLIF) lack substantial support from current evidence. OBJECTIVE We aimed to investigate whether the RA TLIF is superior to FG TLIF in the treatment of lumbar degenerative disease. METHODS We systematically reviewed studies comparing RA versus FG TLIF for lumbar degenerative diseases through July 2022 by searching PubMed, Embase, Web of Science, CINAHL (EBSCO), Chinese National Knowledge Infrastructure (CNKI), WanFang, VIP, and the Cochrane Library, as well as the references of published review articles. Both cohort studies (CSs) and randomized controlled trials (RCTs) were included. Evaluation criteria included the accuracy of percutaneous pedicle screw placement, proximal facet joint violation (FJV), radiation exposure, duration of surgery, estimated blood loss (EBL), and surgical revision. Methodological quality was assessed using the Cochrane risk of bias and ROBINS-I Tool. Random-effects models were used, and the standardized mean difference (SMD) was employed as the effect measure. We conducted subgroup analyses based on surgical type, the specific robot system used, and the study design. Two investigators independently screened abstracts and full-text articles, and the certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS Our search identified 539 articles, of which 21 met the inclusion criteria for quantitative analysis. Meta-analysis revealed that RA had 1.03-folds higher "clinically acceptable" accuracy than FG (RR: 1.0382, 95% CI: 1.0273-1.0493). And RA had 1.12-folds higher "perfect" accuracy than FG group (RR: 1.1167, 95% CI: 1.0726-1.1626). In the case of proximal FJV, our results indicate a 74% reduction in occurrences for patients undergoing RA pedicle screw placement compared to those in the FG group (RR: 0.2606, 95%CI: 0.2063- 0.3293). Seventeen CSs and two RCTs reported the duration of time. The results of CSs suggest that there is no significant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391-0.6131), but the results of RCTs suggest that the patients who underwent RA-TLIF need more surgery time than FG (SMD: 3.7213, 95%CI: 3.0756-4.3669). Sixteen CSs and two RCTs reported the EBL. The results suggest that the patients who underwent RA pedicle screw placement had fewer EBL than FG group (CSs: SMD: -1.9151, 95%CI: -3.1265-0.7036, RCTs: SMD: -5.9010, 95%CI: -8.7238-3.0782). For radiation exposure, the results of CSs suggest that there is no significant difference in radiation time between RA and FG group (SMD: -0.5256, 95%CI: -1.4357-0.3845), but the patients who underwent RA pedicle screw placement had fewer radiation dose than FG group (SMD: -2.2682, 95%CI: -3.1953-1.3411). And four CSs and one RCT reported the number of revision case. The results of CSs suggest that there is no significant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592-1.0495). Our findings are limited by the residual heterogeneity of the included studies, which may limit the interpretation of the results. CONCLUSION In TLIF, RA technology exhibits enhanced precision in pedicle screw placement when compared to FG methods. This accuracy contributes to advantages such as the protection of adjacent facet joints and reductions in intraoperative radiation dosage and blood loss. However, the longer preoperative preparation time associated with RA procedures results in comparable surgical duration and radiation time to FG techniques. Presently, FG screw placement remains the predominant approach, with clinical surgeons possessing greater proficiency in its application. Consequently, the integration of RA into TLIF surgery may not be considered the optimal choice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023441600.
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Affiliation(s)
- Jianbin Guan
- Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
- Shannxi Key Laboratory of Spine Bionic Treatment, Xi'an, China
| | - Ningning Feng
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xing Yu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Kaitan Yang
- Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
- Truma Rehabilitation Department, Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
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3
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Wu J, Fan M, He D, Wei Y, Duan F, Jiang X, Tian W. Accuracy and clinical characteristics of robot-assisted cervical spine surgery: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1903-1914. [PMID: 38613575 DOI: 10.1007/s00264-024-06179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To evaluate the accuracy and feasibility of robot-assisted cervical screw placement and factors that may affect the accuracy. METHODS A comprehensive search was made on PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Med for the selection of potential eligible literature. The outcomes were evaluated in terms of the relative risk (RR) or standardized mean difference (MD) and corresponding 95% confidence interval (CI). Subgroup analyses of the accuracy of screw placement at different cervical segments and with different screw placement approaches were performed. A comparison was made between robotic navigation and conventional freehand cervical screw placement. RESULTS Six comparative cohort studies and five case series studies with 337 patients and 1342 cervical screws were included in this study. The perfect accuracy was 86% (95% CI, 82-89%) and the clinically acceptable rate was 98% (95% CI, 95-99%) in robot-assisted cervical screw placement. The perfect accuracy of robot-assisted C1 lateral mass screw placement was the highest (96%), followed by C6-7 pedicle screw placement (93%) and C2 pedicle screw placement (86%), and the lowest was C3-5 pedicle screw placement (75%). The open approach had a higher perfect accuracy than the percutaneous/intermuscular approach (91% vs 83%). Compared with conventional freehand cervical screw placement, robot-assisted cervical screw placement had a higher accuracy, a lower incidence of perioperative complications, and less intraoperative blood loss. CONCLUSION With good collaboration between the operator and the robot, robot-assisted cervical screw placement is accurate and feasible. Robot-assisted cervical screw placement has a promising prospect.
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Affiliation(s)
- Jiayuan Wu
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Yi Wei
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Xieyuan Jiang
- Trauma Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., Ltd, Beijing, 100035, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
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Vardiman AB, Wallace DJ, Booher GA, Toossi N, Bucklen BS. Decreasing the Pedicle Screw Misplacement Rate in the Thoracic Spine With Robot-guided Navigation. Clin Spine Surg 2023; 36:431-437. [PMID: 37348067 PMCID: PMC10681281 DOI: 10.1097/bsd.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN A retrospective chart review. OBJECTIVE The aim of this study was to evaluate the screw accuracy of thoracic pedicle screws placed with a robot-guided navigation system. SUMMARY OF BACKGROUND DATA Thoracic pedicles are smaller in diameter than lumbar pedicles, making pedicle screw placement difficult. Misplaced pedicle screws may present complications including decreased construct stability, and increased risks of neurological deficits and blood vessel perforation. There is a dearth of knowledge on thoracic pedicle screw accuracy placed with a robot. MATERIALS AND METHODS A retrospective analysis of the robot-assisted placement of thoracic pedicle screws was performed. Preoperative and postoperative computed tomography (CT) scans of the implanted thoracic screws were collected to assess screw placement accuracy, pedicle breadth, and placement deviations. A CT-based Gertzbein and Robbins System was used to classify pedicle screw accuracy in 2 mm increments. A custom image overlay software was used to determine the deviations between the preoperatively planned trajectory of pedicle screws and final placement at screw entry (tail), and tip in addition to the angular deviation. RESULTS Seventy-five thoracic pedicle screws were implanted by navigated robotic guidance in 17 patients, only 1.3% (1/75) were repositioned intraoperatively. Average patient age and body mass index were 57.5 years and 25.9 kg/m 2 , respectively, with 52.9% female patients. Surgery diagnoses were degenerative disk disease (47.1%) and adjacent segment disease (17.6%). There were zero complications, with no returns to the operating room. According to the CT-based Gertzbein and Robbins pedicle screw breach classification system, 93.3% (70/75) screws were grade A or B, 6.6% (5/75) were grade C, and 0% were grade D or E. The average deviation from the preoperative plan to actual final placement was 1.8±1.3 mm for the screw tip, 1.6±0.9 mm for the tail, and 2.1±1.5 degrees of angulation. CONCLUSIONS The current investigation found a 93.3% accuracy of pedicle screw placement in the thoracic spine. Navigated robot assistance is a useful system for placing screws in the smaller pedicles of the thoracic spine. LEVEL OF EVIDENCE Level III-retrospective nonexperimental study.
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Affiliation(s)
- Arnold B. Vardiman
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - David J. Wallace
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Grant A. Booher
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Nader Toossi
- Musculoskeletal Education and Research Center (MERC), Audubon, PA
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Li Y, Wei X, Liang Y, Song G. Robot-assisted versus fluoroscopy-guided pedicle screw fixation of thoracolumbar compression fractures. Medicine (Baltimore) 2023; 102:e36430. [PMID: 38050284 PMCID: PMC10695527 DOI: 10.1097/md.0000000000036430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
The aim of this study is to compare the clinical outcomes and accuracy of robot-assisted (RA) versus fluoroscopy-guided (FG) pedicle screw fixation of thoracolumbar compression fractures. We retrospectively enrolled 85 patients with surgically treated thoracolumbar compression fractures in our study (RA group, 45 patients; FG group, 40 patients). We analyzed the accuracy of pedicle screw placement by using the Gertzbein-Robbins classification, and calculated the one-time success rate (i.e., the rate of screws successfully inserted in the first attempt). We also evaluated volume of blood loss, operative time, visual analogue scale scores for pain, Cobb angle, and postoperative complications. The rates of grade A screw placement (96% vs 68.5%; P < .005), clinically acceptable screw placement (98.2% vs 86%; P < .005), and the one-time success rate (97.3% vs 82.5%; P < .005) were all significantly higher in the RA group than in the FG group. No differences were observed in sex, age, body mass index, volume of blood loss, operative time, visual analogue scale scores, Cobb angle, and postoperative complications between the 2 groups. Compared to FG surgery, RA surgery yielded greater accuracy and one-time success rates of pedicle screw fixation of thoracolumbar compression fractures, with comparable clinical outcomes.
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Affiliation(s)
- Yongjun Li
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xing Wei
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yonghui Liang
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Guangze Song
- Peking University Aerospace School of Clinical Medicine, Beijing, China
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Volk VL, Steele KA, Cinello-Smith M, Chua RV, Pollina J, Poulter G, Shafa E, Busselberg P, Fitzpatrick CK. Pedicle Screw Placement Accuracy in Robot-Assisted Spinal Fusion in a Multicenter Study. Ann Biomed Eng 2023; 51:2518-2527. [PMID: 37458895 DOI: 10.1007/s10439-023-03291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/17/2023] [Indexed: 10/25/2023]
Abstract
Pedicle screw fixation is a spinal fusion technique that involves the implantation of screws into vertebral pedicles to restrict movement between those vertebrae. The objective of this research is to measure pedicle screw placement accuracy using a novel automated measurement system that directly compares the implanted screw location to the planned target in all three anatomical views. Preoperative CT scans were used to plan the screw trajectories in 122 patients across four surgical centers. Postoperative scans were fused to the preoperative plan to quantify placement accuracy using an automated measurement algorithm. The mean medial-lateral and superior-inferior deviations in the pedicle region for 500 screws were 1.75 ± 1.36 mm and 1.52 ± 1.26 mm, respectively. These deviations were measured using an automated system and were statistically different from manually determined values. The uncertainty associated with the fusion of preoperative to postoperative images was also quantified to better understand the screw-to-plan accuracy results. This study uses a novel automated measurement system to quantify screw placement accuracy as it relates directly to the planned target location, instead of analyzing for breaches of the pedicle, to quantify the validity of using of a robotic-guidance system for accurate pedicle screw placement.
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Affiliation(s)
- Victoria L Volk
- Micron School of Materials Science and Engineering, Boise State University, Boise, ID, USA
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Keegan A Steele
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | - Mia Cinello-Smith
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA
| | | | - John Pollina
- Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA
| | | | - Eiman Shafa
- Twin Cities Spine Center, Minneapolis, MN, USA
| | | | - Clare K Fitzpatrick
- Mechanical and Biomedical Engineering, Boise State University, 1910 University Drive, MS-2085, Boise, ID, 83725-2085, USA.
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Pahwa B, Azad TD, Liu J, Ran K, Liu CJ, Tracz J, Sattari SA, Khalifeh JM, Judy BF, Bydon A, Witham TF. Assessing the Accuracy of Spinal Instrumentation Using Augmented Reality (AR): A Systematic Review of the Literature and Meta-Analysis. J Clin Med 2023; 12:6741. [PMID: 37959207 PMCID: PMC10649145 DOI: 10.3390/jcm12216741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements, particularly in the realm of augmented reality (AR), may facilitate more accurate and precise pedicle screw placement. AR integrates virtual data into the operator's real-world view, allowing for the visualization of patient-specific anatomy and navigated trajectories. We aimed to conduct a meta-analysis of the accuracy of pedicle screw placement using AR-based systems. A systematic review of the literature and meta-analysis was performed using the PubMed/MEDLINE database, including studies reporting the accuracy of pedicle screw placement using AR. In total, 8 studies with 163 patients and 1259 screws were included in the analysis. XVision (XVS) was the most commonly used AR system (595 screws) followed by the Allura AR surgical navigation system (ARSN) (462 screws). The overall accuracy was calculated as 97.2% (95% CI 96.2-98.1% p < 0.001). Subgroup analysis revealed that there was no statistically significant difference in the accuracy rates achieved by XVS and Allura ARSN (p = 0.092). AR enables reliable, accurate placement of spinal instrumentation. Future research efforts should focus on comparative studies, cost effectiveness, operative time, and radiation exposure.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences, GTB Hospital, New Delhi 110095, India;
| | - Tej D. Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jiaqi Liu
- School of Medicine, Georgetown University, Washington, DC 20007, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Connor J. Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jovanna Tracz
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jawad M. Khalifeh
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Brendan F. Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Timothy F. Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
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Park C, Shabani S, Agarwal N, Tan L, Mummaneni PV. Robotic-Assisted Surgery and Navigation in Deformity Surgery. Neurosurg Clin N Am 2023; 34:659-664. [PMID: 37718112 DOI: 10.1016/j.nec.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Deformity surgery is advancing quickly with the use of three-dimensional navigation and robotics. In spinal fusion, the use of robotics improves screw placement accuracy and reduces radiation, complications, blood loss, and recovery time. Currently, there is limited evidence showing that robotics is better than traditional freehand techniques. Most studies favoring robotics are small and retrospective due to the novelty of the technology in deformity surgery. Using these systems can also be expensive and time-consuming. Surgeons should use these advancements as tools, but not rely on them to replace surgical experience, anatomy knowledge, and good judgment.
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Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Saman Shabani
- Department of Neurological Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lee Tan
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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9
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La Rocca G, Mazzucchi E, Pignotti F, Nasto LA, Galieri G, Rinaldi P, De Santis V, Pola E, Sabatino G. Navigated, percutaneous, three-step technique for lumbar and sacral screw placement: a novel, minimally invasive, and maximally safe strategy. J Orthop Traumatol 2023; 24:32. [PMID: 37386233 DOI: 10.1186/s10195-023-00696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/02/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Minimally invasive spine surgery is a field of active and intense research. Image-guided percutaneous pedicle screw (PPS) placement is a valid alternative to the standard free-hand technique, thanks to technological advancements that provide potential improvement in accuracy and safety. Herein, we describe the clinical results of a surgical technique exploiting integration of neuronavigation and intraoperative neurophysiological monitoring (IONM) for minimally invasive PPS. MATERIALS AND METHODS An intraoperative-computed tomography (CT)-based neuronavigation system was combined with IONM in a three-step technique for PPS. Clinical and radiological data were collected to evaluate the safety and efficacy of the procedure. The accuracy of PPS placement was classified according to the Gertzbein-Robbins scale. RESULTS A total of 230 screws were placed in 49 patients. Only two screws were misplaced (0.8%); nevertheless, no clinical sign of radiculopathy was experienced by these patients. The majority of the screws (221, 96.1%) were classified as grade A according to Gertzbein-Robbins scale, seven screws were classified as grade B, one screw was classified as grade D, and one last screw was classified as grade E. CONCLUSIONS The proposed three-step, navigated, percutaneous procedure offers a safe and accurate alternative to traditional techniques for lumbar and sacral pedicle screw placement. Level of Evidence Level 3. Trial registration Not applicable.
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Affiliation(s)
- Giuseppe La Rocca
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Edoardo Mazzucchi
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Fabrizio Pignotti
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Luigi Aurelio Nasto
- Department of Orthopaedics and Spine Surgery, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università Della Campania Luigi Vanvitelli, Via De Crecchio 4, 80138, Naples, Italy
| | - Gianluca Galieri
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | | | | | - Enrico Pola
- Department of Orthopaedics and Spine Surgery, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università Della Campania Luigi Vanvitelli, Via De Crecchio 4, 80138, Naples, Italy.
| | - Giovanni Sabatino
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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10
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Pérez de la Torre RA, Ramanathan S, Williams AL, Perez-Cruet M. Minimally-Invasive Assisted Robotic Spine Surgery (MARSS). Front Surg 2022; 9:884247. [PMID: 35903260 PMCID: PMC9316616 DOI: 10.3389/fsurg.2022.884247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Minimally-Invasive robotic spine surgery (MARSS) has expanded the surgeons armamentarium to treat a variety of spinal disorders. In the last decade, robotic developments in spine surgery have improved the safety, accuracy and efficacy of instrumentation placement. Additionally, robotic instruments have been applied to remove tumors in difficult locations while maintaining minimally invasive access. Gross movements by the surgeon are translated into fine, precise movements by the robot. This is exemplified in this chapter with the use of the da Vinci robot to remove apical thoracic tumors. In this chapter, we will review the development, technological advancements, and cases that have been conducted using MARSS to treat spine pathology in a minimally invasive fashion.
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Affiliation(s)
| | - Siddharth Ramanathan
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
| | - Ashley L. Williams
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
| | - Mick J. Perez-Cruet
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
- Michigan Head and Spine Institute, Southfield, MI, United States
- Correspondence: Mick Perez-Cruet
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11
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What Is the Superior Screw Fixation Technique for Posterior Decompression and Fusion in the Management of Cervical Spondylotic Myelopathy: Pedicle Screw or Lateral Mass Screw? Clin Spine Surg 2022; 35:91-94. [PMID: 33264127 DOI: 10.1097/bsd.0000000000001118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
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12
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Himstead AS, Shahrestani S, Brown NJ, Produturi G, Shlobin NA, Al Jammal O, Choi EH, Ransom SC, Daniel Diaz-Aguilar L, Sahyouni R, Abraham M, Pham MH. Bony fixation in the era of spinal robotics: A systematic review and meta-analysis. J Clin Neurosci 2022; 97:62-74. [DOI: 10.1016/j.jocn.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 01/02/2023]
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13
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Driver J, Dorman JK, Chi JH. A Novel Mobile Device-Based Navigation System for Placement of Posterior Spinal Fixation. Oper Neurosurg (Hagerstown) 2022; 22:249-254. [DOI: 10.1227/ons.0000000000000116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
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14
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State of the art review of new technologies in spine deformity surgery-robotics and navigation. Spine Deform 2022; 10:5-17. [PMID: 34487345 PMCID: PMC8741671 DOI: 10.1007/s43390-021-00403-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/14/2021] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN/METHODS Review article. OBJECTIVES The goal of this article is to review the available evidence for computerized navigation and robotics as an accuracy improvement tool for spinal deformity surgery, as well as to consider potential complications, impact on clinical outcomes, radiation exposure, and costs. Pedicle screw and rod construct are widely utilized for posterior spinal fixation in spinal deformity correction. Freehand placement of pedicle screws has long been utilized, although there is variable potential for inaccuracy depending on surgeon skill and experience. Malpositioned pedicle screws may have significant clinical implications ranging from nerve root irritation, inadequate fixation, CSF leak, perforation of the great vessels, or spinal cord damage. Computer-based navigation and robotics systems were developed to improve pedicle screw insertion accuracy and consistency, and decrease the risk of malpositioned pedicle fixation. The available evidence suggests that computer-based navigation and robotic-assisted guidance systems for pedicle cannulation are at least equivalent, and in several reports superior, to freehand techniques in terms of accuracy. CT and robotic navigation systems do appear to decrease radiation exposure to the operative team in some reports. Published reports do indicate longer operative times with use of robotic navigation compared with traditional freehand techniques for pedicle screw placement. To date, there is no conclusive evidence that use of CT or robotic navigation has any measurable impact on patient outcomes or overall complication reduction. There are theoretical advantages with robotic and CT navigation in terms of both speed and accuracy for severe spinal deformity or complex revision cases, however, there is a need for studies to investigate this technology in these specific cases. There is no evidence to date demonstrating the cost effectiveness of CT or robotic navigation as compared with traditional pedicle cannulation techniques. CONCLUSIONS The review of available evidence suggests that computer-based navigation and robotic-assisted guidance systems for pedicle cannulation are at least equivalent, and in several reports superior, to freehand techniques in terms of radiographic accuracy. There is no current clinical evidence that the use of navigation or robotic techniques leads to improved patient outcomes or decreased overall complications or reoperation rates, and the use of these systems may substantially increase surgical costs. LEVEL OF EVIDENCE V.
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15
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Sivaganesan A, Clark NJ, Alluri RK, Vaishnav AS, Qureshi SA. Robotics and Spine Surgery: Lessons From the Personal Computer and Industrial Revolutions. Int J Spine Surg 2021; 15:S21-S27. [PMID: 34675028 DOI: 10.14444/8137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Over the past decade, several review articles have evaluated the techniques and outcomes of robotics vs traditional methods in spine surgery. Recently, robot-assisted pedicle screw placement has emerged, representing an important milestone in the evolution of spine surgery. In the present article, the authors aim to provide the historical context regarding the use and growth of spinal robotics through the lens of the Industrial Revolution and the personal computer revolution. While the former provides insight into the current implications of robotics in spine surgery, the latter predicts future steps in this arena.
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Affiliation(s)
| | | | - Ram K Alluri
- Hospital for Special Surgery, New York, New York
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medical College, New York, New York
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16
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Jin M, Ge M, Lei L, Li F, Wu M, Zhang G, Pei S, Zheng B. Clinical and Radiologic Outcomes of Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Comparative Study. World Neurosurg 2021; 158:e1-e9. [PMID: 34637939 DOI: 10.1016/j.wneu.2021.10.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Making surgery as less aggressive as possible is best for elderly patients with osteoporotic vertebral compression fractures (OVCFs). Recently, we attempted a more precise, minimally invasive, and robot-assisted kyphoplasty in our clinical setting. OBJECTIVE We sought to compare the clinical and radiologic outcomes of robot-assisted percutaneous kyphoplasty (rPKP) with those of fluoroscopy-assisted percutaneous kyphoplasty (fPKP) in treating OVCFs. METHODS We retrospectively reviewed the clinical and radiologic data of patients with single-segment OVCF who received either rPKP or fPKP between January 2020 and December 2020 at our institution. The operation time, injected volume of cement, length of hospital stays, visual analog scale for back pain, Oswestry Disability Index, local kyphosis angle (LKA), height of fractured vertebra (HFV), and perioperative complications were compared between the 2 groups. RESULTS A total of 212 cases were included in this study, among whom 81 cases received rPKP and 131 cases received fPKP. Both techniques exhibited satisfying improvement in pain relief and radiologic outcomes. Specifically, the rPKP costed less operation time and achieved better correction and maintenance regarding LKA, HFV, and instant pain relief (P < 0.05). The length of hospital stays, incidence of cement leakage, visual analog scale for back pain, and Oswestry Disability Index at final follow-up were comparable between 2 groups. CONCLUSIONS rPKP provides a precise puncture and exhibits superiority in the correction and maintenance of LKA and HFV when compared with traditional fPKP. The cost-effectiveness and specific application scenarios of this technique shall be confirmed via further extensive studies.
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Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Meng Ge
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Longyue Lei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Fengqing Li
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Mujun Wu
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Guang Zhang
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Shaolong Pei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Biao Zheng
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China.
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17
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Driver J, Groff MW. Editorial. Navigation in spine surgery: an innovation here to stay. J Neurosurg Spine 2021:1-3. [PMID: 34624836 DOI: 10.3171/2021.4.spine21207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joseph Driver
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael W Groff
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Li J, Wang Z, Zeng L, Liu Z, Hu W, Yu M. Application and Evaluation of an Independent Robotic Arm System in K-wire Placement for Lumbar Fusion. Clin Spine Surg 2021; 34:E466-E476. [PMID: 34050044 DOI: 10.1097/bsd.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A single-center randomized controlled study. OBJECTIVE The objective of this study was to introduce a novel robotic system with an independent arm ("Orthbot Intelligent Orthopedic Minimally Invasive System"; Xin Junte Surgical Technologies) that has been developed and tested as a surgical assistant for autoplacement of the Kirschner wire (K-wire) in lumbar fusion, and to evaluate its accuracy by comparing it with the conventional free-hand instrumentation. SUMMARY OF BACKGROUND DATA Robotic technology has performed excellently in spine surgeries and has demonstrated high clinical value and potential. Robot-assisted spinal surgery is now being promoted as a paradigm for technology-led advancement. MATERIALS AND METHODS A total of 24 patients were recruited and assigned randomly to the robotic arm group (RG) or the free-hand group (FG). Deviation distance and deviation angle (DA) of K-wire placement were measured and compared between the RG and the FG. RESULTS The average deviation distance was 0.88±0.08 mm in the RG and 5.13±1.68 mm in the FG (P<0.001). In both coronal and sagittal radiographs, the average DA of K-wire placement was smaller in the RG (P<0.05), and in both axial and sagittal computed tomography scans, the average DA of pedicle screw placement was also lower in the RG (P<0.05), which indicated higher accuracy of the robotic system. CONCLUSIONS The novel robotic system in this study has shown certain advantages over the conventional free-hand approach in K-wire placement for lumbar fusion, including being more accurate in K-wire placement, fully automatic, and more adaptive to preoperative plans. Although the robotic arm proves to be promising in our results, the small sample size in this clinical study necessitates further multicenter, large sample follow-up studies to verify its advantages.
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Affiliation(s)
| | - Zizhen Wang
- Department of Clinical Medicine, Peking University Health Science Center, Beijing, China
| | - Lin Zeng
- Clinical Epidemiological Research Center, Peking University Third Hospital
| | | | - Wanheng Hu
- Department of Science and Technology Studies, Cornell University, Ithaca, NY
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19
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Li C, Li W, Gao S, Cao C, Li C, He L, Ma X, Li M. Comparison of accuracy and safety between robot-assisted and conventional fluoroscope assisted placement of pedicle screws in thoracolumbar spine: A meta-analysis. Medicine (Baltimore) 2021; 100:e27282. [PMID: 34559135 PMCID: PMC8462633 DOI: 10.1097/md.0000000000027282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/01/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis is to explore the screw positioning accuracy, complications related to pedicle screw implantation, revision rate and radiation exposure between robot screw placement and traditional fluoroscopic screw placement. METHODS We searched several databases, including CNKI, Wanfang database, cqvip datebase, PubMed, Cochrane library and EMBASE, to identify articles that might meet the criteria. Meta-analysis was performed using Revman 5.3 software. RESULTS A total of 13 randomized controlled trial were included. The results showed that the pedicle screw accuracy of the robot assisted group was significantly better than that of the conventional freehand (FH) group (OR = 3.5, 95% confidence interval [CI] [2.75,4.45], P < .0001). There was no significant difference in the complications caused by pedicle screw implantation between the robot-assisted group and the conventional FH group [OR = 0.39, 95%CI (0.10,1.48), P = .17]. The rate of facet joint invasion in the robot-assisted group was significantly lower than that in the conventional FH group (OR = 0.06, 95%CI [0.01,0.29], P = .0006). The revision rate in the robot-assisted group was significantly lower than that in the conventional FH group (OR = 0.19, 95%CI [0.05,0.71], P = 0.0.01). There was no significant difference in the average radiation of pedicle screws implantation between the robot-assisted group and the conventional FH (mean difference = -7.94, 95%CI [-20.18,4.30], P = .20). CONCLUSION The robot-assisted group was significantly better than the conventional FH in the accuracy of pedicle screw placement and facet joint invasion rate and revision rate. There was no significant difference in the complication and fluoroscopy time between the two groups.
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Affiliation(s)
- Chuntao Li
- Hebei North University, Zhangjiakou, Hebei, China
| | - Wenyi Li
- Department of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shangju Gao
- Department of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Can Cao
- Department of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Changren Li
- Hebei North University, Zhangjiakou, Hebei, China
| | - Liang He
- Hebei North University, Zhangjiakou, Hebei, China
| | - Xu Ma
- Hebei North University, Zhangjiakou, Hebei, China
| | - Meng Li
- Hebei Medical University, Shijiazhuang, Hebei, China
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20
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Soliman MA, Khan A, O'Connor TE, Foley K, Pollina J. Accuracy and Efficiency of Fusion Robotics™ Versus Mazor-X™ in Single-Level Lumbar Pedicle Screw Placement. Cureus 2021; 13:e15939. [PMID: 34211815 PMCID: PMC8236238 DOI: 10.7759/cureus.15939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction There has been a surge in robot utilization in spine surgery over the past five years with the rapid development of new spine robotic platforms. This study aimed to compare a new robotic spine platform from Fusion RoboticsTM (Fusion Robotics, Helena, MT) with the widely used Mazor-XTM Stealth Edition robotic platform (Medtronic, Dublin, Ireland) in terms of workflow and lumbar pedicle screw placement accuracy. Methods A cadaver lab was conducted, which included four procedures with single-level lumbar pedicle screw placement using the Fusion RoboticsTM system. These four procedures were compared to four propensity-score matched cases with single-level lumbar pedicle screw placement using the Mazor-XTM Stealth Edition. A single surgeon performed all surgeries. The cases were matched in terms of demographics (age, sex, race, BMI) and comorbidities (Charlson Comorbidity Index score). The primary outcome measure was the operative workflow efficiency (duration as measured with a stopwatch by an independent observer). The secondary outcome measures were pedicle screw accuracy and accuracy to plan. Results After propensity-score matching, there were four cases in each group with no significant between-group differences in terms of sex, race, BMI, or surgical levels; however, there were significant differences in terms of age (p=0.01) and comorbidities (p<0.001). The workflow efficiency measurement showed that the Fusion RoboticsTM platform had a significantly shorter duration in terms of the system set-up time, planning to in-position time, and total procedure time (p<0.05). However, there was no significant difference between the robotic platforms in terms of creating a sterile barrier, scanning and importing images, creating a plan, screw placement, screw accuracy, and screw accuracy to plan. Conclusion Based on our findings, the Fusion RoboticsTM platform had a significantly shorter procedure workflow duration while maintaining the same accuracy as the most commonly used robotic platform (Mazor-XTM). This is the first study to directly compare different spine surgery robotic systems.
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Affiliation(s)
- Mohamed A Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA.,Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, EGY
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
| | - Timothy E O'Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
| | - Kevin Foley
- Department of Neurosurgery, Semmes-Murphey Clinic & University of Tennessee Health Science Center, Memphis, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
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21
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Molina CA, Sciubba DM, Greenberg JK, Khan M, Witham T. Clinical Accuracy, Technical Precision, and Workflow of the First in Human Use of an Augmented-Reality Head-Mounted Display Stereotactic Navigation System for Spine Surgery. Oper Neurosurg (Hagerstown) 2021; 20:300-309. [PMID: 33377137 DOI: 10.1093/ons/opaa398] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Augmented reality mediated spine surgery is a novel technology for spine navigation. Benchmark cadaveric data have demonstrated high accuracy and precision leading to recent regulatory approval. Absence of respiratory motion in cadaveric studies may positively bias precision and accuracy results and analogous investigations are prudent in live clinical scenarios. OBJECTIVE To report a technical note, accuracy, precision analysis of the first in-human deployment of this technology. METHODS A 78-yr-old female underwent an L4-S1 decompression, pedicle screw, and rod fixation for degenerative spine disease. Six pedicle screws were inserted via AR-HMD (xvision; Augmedics, Chicago, Illinois) navigation. Intraoperative computed tomography was used for navigation registration as well as implant accuracy and precision assessment. Clinical accuracy was graded per the Gertzbein-Robbins (GS) scale by an independent neuroradiologist. Technical precision was analyzed by comparing 3-dimensional (3D) (x, y, z) virtual implant vs real implant position coordinates and reported as linear (mm) and angular (°) deviation. Present data were compared to benchmark cadaveric data. RESULTS Clinical accuracy (per the GS grading scale) was 100%. Technical precision analysis yielded a mean linear deviation of 2.07 mm (95% CI: 1.62-2.52 mm) and angular deviation of 2.41° (95% CI: 1.57-3.25°). In comparison to prior cadaveric data (99.1%, 2.03 ± 0.99 mm, 1.41 ± 0.61°; GS accuracy 3D linear and angular deviation, respectively), the present results were not significantly different (P > .05). CONCLUSION The first in human deployment of the single Food and Drug Administration approved AR-HMD stereotactic spine navigation platform demonstrated clinical accuracy and technical precision of inserted hardware comparable to previously acquired cadaveric studies.
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Affiliation(s)
- Camilo A Molina
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jacob K Greenberg
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Majid Khan
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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Zheng Y, Yang J, Zhang F, Lu J, Qian Y. Robot-assisted vs freehand cannulated screw placement in femoral neck fractures surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25926. [PMID: 34011064 PMCID: PMC8137053 DOI: 10.1097/md.0000000000025926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Several studies have reported that medical robot-assisted method (RA) might be superior to conventional freehand method (FH) in orthopedic surgery. Yet the results are still controversial, especially in terms of femoral neck fractures surgery. Here, 2 methods were assessed based on current evidence. METHODS Electronic databases including Cochrane Library, PubMed, Web of Science. and EMBASE were selected to retrieved to identify eligible studies between freehand and RAs in femoral neck fractures, with 2 reviewers independently reviewing included studies as well as collecting data. RESULTS A total of 5 studies with 331 patients were included. Results indicated that 2 surgical methods were equivalent in terms of surgical duration, Harris score, fracture healing time, fracture healing proportion and complications, while RA showed clinical benefits in radiation exposure, intraoperative bleeding, total drilling times, and screw parallelism. CONCLUSIONS Current literature revealed significantly difference between 2 techniques and suggested that RA might be beneficial for patients than freehand method.
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Affiliation(s)
- Yongshun Zheng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University
| | - Jiazhao Yang
- Department of Orthopedics, Anhui Provincial Hospital
| | - Fan Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jinsen Lu
- Department of Orthopedics, Anhui Provincial Hospital
| | - Yeben Qian
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University
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23
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Shi B, Jiang T, Du H, Zhang W, Hu L, Zhang L. Application of Spinal Robotic Navigation Technology to Minimally Invasive Percutaneous Treatment of Spinal Fractures: A Clinical, Non-Randomized, Controlled Study. Orthop Surg 2021; 13:1236-1243. [PMID: 33942548 PMCID: PMC8274181 DOI: 10.1111/os.12993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To introduce a new robotic navigation system that assists pedicle screw implantation and verify the accuracy and stability of the system. Methods Pedicle screw placements were performed on the thoracic vertebrae (T)9–Lumbar vertebrae (L)5 thoracolumbar vertebrae of cadavers using robotic guidance. The operative duration, puncture success, correction, and correction time were assessed. Additionally, a total of 30 thoracolumbar fractures from September 2017 until June 2019 were included in a clinical study. Two groups were evaluated: the robotic guidance group and freehand group. Both sexes were evaluated. Mean ages were 47.0 and 49.1 years, respectively, in the robotic and freehand groups. Inclusion criteria was age >18 years and a thoracolumbar fracture. Intervention was the operative treatment of thoracolumbar fractures. Outcome parameters were the operation time, intraoperative bleeding, and fluoroscopic data. The accuracy of the pedicle screw placement and screw penetration rate of the two groups were compared using intraoperative fluoroscopic axial images. Results The success rate for 108 one‐time nail placements in cadavers was 88% and two‐time nail placement was 100%. Vertebral punctures at L5 took the longest to perform and achieve correction. Clinically, there were no significant differences in patients' sex, body mass index, age distribution, or intraoperative bleeding between the groups. The average X‐ray exposure time for patients and operators were 37.69 ± 9.24 s and 0 s in the robotic group (significantly lower than in the freehand group: 81.24 ± 6.97 s vs 56.29 ± 7.93 s, respectively). Success rates for one‐time screw placements were 98.64 and 88.46% in the robotic and freehand groups, respectively, which is significant. Screw penetration rates (1.36% vs 11.54%, robotic vs freehand), were significantly different. Conclusions The robotic system improved the accuracy and safety of pedicle screw internal fixation and reduced patients' and operators' intraoperative radiation exposure.
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Affiliation(s)
- Bin Shi
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Tianyu Jiang
- Department of Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Hailong Du
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Lei Hu
- Robotics Institute, Beihang University, Beijing, China
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Fu W, Tong J, Liu G, Zheng Y, Wang S, Abdelrahim MEA, Gong S. Robot-assisted technique vs conventional freehand technique in spine surgery: A meta-analysis. Int J Clin Pract 2021; 75:e13964. [PMID: 33370470 DOI: 10.1111/ijcp.13964] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impact of robot-assisted techniques versus conventional freehand techniques in terms of the accuracy of pedicle screw placement remains conflicting. This meta-analysis was performed to evaluate this relationship. METHODS A systematic literature search up to July 2020 was performed and 15 studies were detected with 6041 pedicle screw placements with 2748 of them were using robot-assisted techniques and 3293 were conventional freehand techniques. They reported relationships between robot-assisted techniques and conventional freehand techniques in pedicle screw placement. Odds ratio (OR) or Mean differences (MD) with 95% confidence intervals (CIs) was calculated comparing the robot-assisted techniques to conventional freehand techniques in pedicle screw placement risks using the dichotomous and continuous method with a random or fixed-effect model. RESULTS Robot-assisted techniques had a significantly higher screw position grade A in Gertzbein-Robbins classification of the screw placement accuracy (OR, 2.43; 95% CI, 1.66-3.54, P < .001); shorter postoperative stay (MD, -0.67; 95% CI, -1.16 to -0.19, P < .001); lower intraoperative blood loss (MD, -91.64; 95% CI, -152.44 to -30.83, P = .003); fewer intraoperative radiation dose (MD, -23.52; 95% CI, -40.12 to -6.0.93, P = .005); and low proximal facet violations (MD, 0.08; 95% CI, 0.03-0.20, P < .001) compared with conventional freehand techniques. However, no significant difference was found between robot-assisted techniques and conventional freehand techniques in surgical time (OR, 11.71; 95% CI, 03.27-26.70, P = .13); visual analogue scale scores (MD, -0.15; 95% CI, -0.54 to 0.23, P = .44); and Oswestry disability index scores (MD, 0.21; 95% CI, -5.09-5.51, P = .94). CONCLUSIONS The extent of the improvement with robot-assisted techniques in screw position grade A in Gertzbein-Robbins classification of the screw placement accuracy, postoperative stay, intraoperative blood loss, intraoperative radiation dose, and proximal facet violations was significantly better than conventional freehand techniques. This relationship forces us to recommend robot-assisted techniques for pedicle screw placement to avoid any possible negative postoperative results.
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Affiliation(s)
- Weiguang Fu
- Department of Spinal Surgery, the 215 Hospital of shaanxi nuclear industry, Xianyang, China
| | - Jie Tong
- Department of Spinal Surgery, Affiliated Chenzhou Hospital, The First School of Clinical Medicine, Southern Medical University (The First People's Hospital of Chenzhou), Chenzhou, Hunan, 423000, China
| | - Gang Liu
- Department of Spinal Surgery, the 215 Hospital of shaanxi nuclear industry, Xianyang, China
| | - Yuxin Zheng
- Department of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shaolei Wang
- Department of Orthopaedic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Shaohua Gong
- Department of Spinal Surgery, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J 2021; 21:181-192. [PMID: 32976997 DOI: 10.1016/j.spinee.2020.09.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The introduction and integration of robot technology into modern spine surgery provides surgeons with millimeter accuracy for pedicle screw placement. Coupled with computer-based navigation platforms, robot-assisted spine surgery utilizes augmented reality to potentially improve the safety profile of instrumentation. PURPOSE In this study, the authors seek to determine the safety and efficacy of robotic-assisted pedicle screw placement compared to conventional free-hand (FH) technique. STUDY DESIGN/SETTING We conducted a systematic review of the electronic databases using different MeSH terms from 1980 to 2020. OUTCOME MEASURES The present study measures pedicle screw accuracy, complication rates, proximal-facet joint violation, intraoperative radiation time, radiation dosage, and length of surgery. RESULTS A total of 1,525 patients (7,379 pedicle screws) from 19 studies with 777 patients (51.0% with 3,684 pedicle screws) in the robotic-assisted group were included. Perfect pedicle screw accuracy, as categorized by Gerztbein-Robbin Grade A, was significantly superior with robotic-assisted surgery compared to FH-technique (Odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.20-2.35; p=.003). Similarly, clinically acceptable pedicle screw accuracy (Grade A+B) was significantly higher with robotic-assisted surgery versus FH-technique (OR: 1.54, 95% CI: 1.01-2.37; p=.05). Furthermore, the complication rates and proximal-facet joint violation were 69% (OR: 0.31, 95% CI: 0.20-0.48; p<.00001) and 92% less likely (OR: 0.08, 95% CI: 0.03-0.20; p<.00001) with robotic-assisted surgery versus FH-group. Robotic-assisted pedicle screw implantation significantly reduced intraoperative radiation time (MD: -5.30, 95% CI: -6.83-3.76; p<.00001) and radiation dosage (MD: -3.70, 95% CI: -4.80-2.60; p<.00001) compared to the conventional FH-group. However, the length of surgery was significantly higher with robotic-assisted surgery (MD: 22.70, 95% CI: 6.57-38.83; p=.006) compared to the FH-group. CONCLUSION This meta-analysis corroborates the accuracy of robot-assisted pedicle screw placement.
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Jin M, Lei L, Li F, Zheng B. Does Robot Navigation and Intraoperative Computed Tomography Guidance Help with Percutaneous Endoscopic Lumbar Discectomy? A Match-Paired Study. World Neurosurg 2020; 147:e459-e467. [PMID: 33385595 DOI: 10.1016/j.wneu.2020.12.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of robot-assisted percutaneous endoscopic lumbar discectomy (rPELD) using a specially designed orthopaedic robot with an intraoperative computed tomography-equipped suite for treatment of symptomatic lumbar disc herniation and compare rPELD with fluoroscopy-assisted percutaneous endoscopic lumbar discectomy (fPELD). METHODS We retrospectively reviewed and compared demographic data, radiologic workups, and patient-reported outcomes of 39 patients treated with rPELD and 78 patients treated with fPELD at our institution between January 2019 and December 2019. RESULTS Our data showed that a single-shot puncture in the rPELD group was significantly more precise compared with 4.12 ± 1.71 trials in the fPELD group (P < 0.001). There was an overall reduction of fluoroscopy (21.33 ± 3.89 times vs. 33.06 ± 2.92 times, P < 0.001), puncture-channel time (13.34 ± 3.03 minutes vs. 15.03 ± 4.5 minutes, P = 0.038), and total operative time (57.46 ± 7.49 minutes vs. 69.40 ± 12.59 minutes, P < 0.001) using the rPELD technique versus the fPELD technique. However, there were no significant differences in patient-reported outcomes, length of hospital stay, and complication rate between the 2 groups (P > 0.05). CONCLUSIONS Taken together, our data indicate that rPELD provides a precise skin entry point and optimal trajectory for puncture, which increases the success rate of PELD, negating the need for revision surgery. However, further studies are required to confirm the superiority and application of the rPELD technique.
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Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Longyue Lei
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China
| | - Fengqing Li
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China
| | - Biao Zheng
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China.
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Molina CA, Phillips FM, Colman MW, Ray WZ, Khan M, Orru' E, Poelstra K, Khoo L. A cadaveric precision and accuracy analysis of augmented reality-mediated percutaneous pedicle implant insertion. J Neurosurg Spine 2020; 34:316-324. [PMID: 33126206 DOI: 10.3171/2020.6.spine20370] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Augmented reality-mediated spine surgery (ARMSS) is a minimally invasive novel technology that has the potential to increase the efficiency, accuracy, and safety of conventional percutaneous pedicle screw insertion methods. Visual 3D spinal anatomical and 2D navigation images are directly projected onto the operator's retina and superimposed over the surgical field, eliminating field of vision and attention shift to a remote display. The objective of this cadaveric study was to assess the accuracy and precision of percutaneous ARMSS pedicle implant insertion. METHODS Instrumentation was placed in 5 cadaveric torsos via ARMSS with the xvision augmented reality head-mounted display (AR-HMD) platform at levels ranging from T5 to S1 for a total of 113 total implants (93 pedicle screws and 20 Jamshidi needles). Postprocedural CT scans were graded by two independent neuroradiologists using the Gertzbein-Robbins scale (grades A-E) for clinical accuracy. Technical precision was calculated using superimposition analysis employing the Medical Image Interaction Toolkit to yield angular trajectory (°) and linear screw tip (mm) deviation from the virtual pedicle screw position compared with the actual pedicle screw position on postprocedural CT imaging. RESULTS The overall implant insertion clinical accuracy achieved was 99.1%. Lumbosacral and thoracic clinical accuracies were 100% and 98.2%, respectively. Specifically, among all implants inserted, 112 were noted to be Gertzbein-Robbins grade A or B (99.12%), with only 1 medial Gertzbein-Robbins grade C breach (> 2-mm pedicle breach) in a thoracic pedicle at T9. Precision analysis of the inserted pedicle screws yielded a mean screw tip linear deviation of 1.98 mm (99% CI 1.74-2.22 mm) and a mean angular error of 1.29° (99% CI 1.11°-1.46°) from the projected trajectory. These data compare favorably with data from existing navigation platforms and regulatory precision requirements mandating that linear and angular deviation be less than 3 mm (p < 0.01) and 3° (p < 0.01), respectively. CONCLUSIONS Percutaneous ARMSS pedicle implant insertion is a technically feasible, accurate, and highly precise method.
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Affiliation(s)
- Camilo A Molina
- 1Department of Neurosurgery, Washington University School of Medicine in St. Louis, Missouri
| | - Frank M Phillips
- 3Department of Orthopedic Surgery, Rush University School of Medicine, Chicago, Illinois
| | - Matthew W Colman
- 3Department of Orthopedic Surgery, Rush University School of Medicine, Chicago, Illinois
| | - Wilson Z Ray
- 1Department of Neurosurgery, Washington University School of Medicine in St. Louis, Missouri
| | - Majid Khan
- 2Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emanuele Orru'
- 4Department of Neurointerventional Radiology, Lahey Clinic Tufts University School of Medicine, Boston, Massachusetts
| | - Kornelis Poelstra
- 5The Robotic Spine Institute of Silicon Valley at OrthoNorCal, Los Gatos, California; and
| | - Larry Khoo
- 6The Spine Clinic of Los Angeles, California
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Li W, Li G, Chen W, Cong L. The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease: a meta-analysis. Bone Joint Res 2020; 9:653-666. [PMID: 33101655 PMCID: PMC7547641 DOI: 10.1302/2046-3758.910.bjr-2020-0064.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims The aim of this study was to systematically compare the safety and accuracy of robot-assisted (RA) technique with conventional freehand with/without fluoroscopy-assisted (CT) pedicle screw insertion for spine disease. Methods A systematic search was performed on PubMed, EMBASE, the Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), and WANFANG for randomized controlled trials (RCTs) that investigated the safety and accuracy of RA compared with conventional freehand with/without fluoroscopy-assisted pedicle screw insertion for spine disease from 2012 to 2019. This meta-analysis used Mantel-Haenszel or inverse variance method with mixed-effects model for heterogeneity, calculating the odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence intervals (CIs). The results of heterogeneity, subgroup analysis, and risk of bias were analyzed. Results Ten RCTs with 713 patients and 3,331 pedicle screws were included. Compared with CT, the accuracy rate of RA was superior in Grade A with statistical significance and Grade A + B without statistical significance. Compared with CT, the operating time of RA was longer. The difference between RA and CT was statistically significant in radiation dose. Proximal facet joint violation occurred less in RA than in CT. The postoperative Oswestry Disability Index (ODI) of RA was smaller than that of CT, and there were some interesting outcomes in our subgroup analysis. Conclusion RA technique could be viewed as an accurate and safe pedicle screw implantation method compared to CT. A robotic system equipped with optical intraoperative navigation is superior to CT in accuracy. RA pedicle screw insertion can improve accuracy and maintain stability for some challenging areas.Cite this article: Bone Joint Res 2020;9(10):653-666.
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Affiliation(s)
- Weishang Li
- Department of Orthopedic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Gaoyu Li
- Department of Obstetrics and Gynecology, Shengjing hospital of China Medical University, Shenyang, China
| | - Wenting Chen
- Disease Control and Prevention Center, China Railway Shenyang Bureau Group Corporation, Shengyang, China
| | - Lin Cong
- Department of Orthopedic Surgery, The First Hospital of China Medical University, Shenyang, China
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Kalidindi KKV, Sharma JK, Jagadeesh NH, Sath S, Chhabra HS. Robotic spine surgery: a review of the present status. J Med Eng Technol 2020; 44:431-437. [PMID: 32886014 DOI: 10.1080/03091902.2020.1799098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
With technological advancements being introduced and dominating many fields, spine surgery is no exception. In view of the patient safety and surgeon's comfort, robotics has been introduced in spine surgery. Due to small corridors for work, little room for inaccuracy, lengthy and tedious procedures, spine surgery is an ideal scenario for robotics to establish as the standard of care. Spine robotics received their first FDA clearance in 2004. New generation of spine robotics with integrated navigation systems has become available now. The primary role of spine robotics, at present, is to aid pedicle screw fixation. High quality studies have been performed to establish its role in increasing the accuracy of pedicle fixation. Studies have also reported decreased radiation and decreased operative time with spine robotics. However, few studies have reported otherwise. It is still in its nascent stage in both industrial view and surgeon familiarity. Continued research to overcome the challenges such as high cost and steep learning curve is crucial for its widespread use. Also, expanding the scope of spine robotics beyond pedicle screw fixation such as osteotomies and dural procedures would be an area for potential research. This review is intended to provide an overview of various studies in the field of robotic spine surgery and its present status.
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Affiliation(s)
| | - Jeevan Kumar Sharma
- Department of Spine Service, Indian Spinal Injuries Centre, New Delhi, India
| | | | - Sulaiman Sath
- Department of Spine Service, Indian Spinal Injuries Centre, New Delhi, India
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Murata K, Fujibayashi S, Otsuki B, Shimizu T, Masamoto K, Matsuda S. Accuracy of fluoroscopic guidance with the coaxial view of the pedicle for percutaneous insertion of lumbar pedicle screws and risk factors for pedicle breach. J Neurosurg Spine 2020; 34:52-59. [PMID: 32858519 DOI: 10.3171/2020.5.spine20291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study the authors aimed to evaluate the rate of malposition, including pedicle breach and superior facet violation, after percutaneous insertion of pedicle screws using the coaxial fluoroscopic view of the pedicle, and to assess the risk factors for pedicle breach. METHODS In total, 394 percutaneous screws placed in 85 patients using the coaxial fluoroscopic view of the pedicle between January 2014 and September 2017 were assessed, and 445 pedicle screws inserted in 116 patients using conventional open procedures were used for reference. Pedicle breach and superior facet violation were evaluated by postoperative 0.4-mm slice CT. RESULTS Superior facet violation was observed in 0.5% of the percutaneous screws and 1.8% of the conventionally inserted screws. Pedicle breach occurred more frequently with percutaneous screws (28.9%) than with conventionally inserted screws (11.9%). The breaches in percutaneous screws were minor and did not reduce the interbody fusion rate. The angle difference between the percutaneous and conventionally inserted screws was comparable. Insertion at the L3 or L4 level, right-sided insertion, placement around a trefoil canal, smaller pedicle angle, and a small difference between the screw and pedicle diameters were found to be risk factors for pedicle breach by percutaneous pedicle screws. CONCLUSIONS Percutaneous pedicle screw placement using the coaxial fluoroscopic view of the pedicle carries a low risk of superior facet violation. The screws should be placed carefully considering the level and side of insertion, canal shape, and pedicle angle.
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Barsotti CE, Gavassi BM, Prado FE, Batista BN, de Resende Pratali R, Ribeiro AP, de Oliveira CES, Ferreira RR. Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study. BMC Musculoskelet Disord 2020; 21:473. [PMID: 32689992 PMCID: PMC7372782 DOI: 10.1186/s12891-020-03491-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
Background To investigate in the conventional techniques of the pedicle screws using triggered screw electromyography (t-EMG), considering different threshold cutoffs: 10, 15, 20 25 mA, for predicting pedicle screw positioning during surgery of the adolescent with idiopathic scoliosis (AIS). Methods Sixteen patients (4 males, 12 females, average age 16.6 years) were included, with an average curve magnitude of 50 degrees and placement of 226 pedicle screws. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG considering different threshold cutoffs (10,15, 20 and 25 mA) in the axial and Sagittal planes for predicting screw positions ARNI was investigated. Results The EMG exam accuracy, in the axial plane, 90.3% screws were considered NRNI. In the sagittal plane, 81% pedicle screws were considered NRNI. A 1-mA decrease in the EMG threshold was associated with a 12% increase in the odds of the screw position ARNI. In the axial and sagittal planes, the ORs were 1.09 and 1.12, respectively. At every threshold cutoff evaluated, the PPV of EMG for predicting screws ARNI was very low in the different threshold cutoff (10 and 15); the highest PPV was 18% with a threshold cutoff of 25 mA. The PPV was always slightly higher for predicting screws ARNI in the sagittal plane than in the axial plane. In contrast, there was a moderate to high NPV (78–93%) for every cutoff analyzed. Conclusions EMG had a moderate to high accuracy for positive predicting value screws ARNI with increase threshold cutoffs of 20 and 25 mA. In addition, showed to be effective for minimizing false-negative screws ARNI in the different threshold cutoffs of the EMG in adolescent with idiopathic scoliosis (AIS).
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Affiliation(s)
- Carlos Eduardo Barsotti
- Spine Group, Institute of Medical Assistance to the State Public Hospital Servant - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 180, São Paulo, SP, CEP: 04038-034, Brazil.
| | - Bruno Moreira Gavassi
- Spine Group, Institute of Medical Assistance to the State Public Hospital Servant - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 180, São Paulo, SP, CEP: 04038-034, Brazil
| | - Francisco Eugenio Prado
- Spine Group, Institute of Medical Assistance to the State Public Hospital Servant - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 180, São Paulo, SP, CEP: 04038-034, Brazil
| | - Bernardo Nogueira Batista
- Spine Group, Institute of Medical Assistance to the State Public Hospital Servant - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 180, São Paulo, SP, CEP: 04038-034, Brazil
| | - Raphael de Resende Pratali
- Spine Group, Institute of Medical Assistance to the State Public Hospital Servant - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 180, São Paulo, SP, CEP: 04038-034, Brazil
| | | | - Carlos Eduardo Soares de Oliveira
- Spine Group, Institute of Medical Assistance to the State Public Hospital Servant - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 180, São Paulo, SP, CEP: 04038-034, Brazil
| | - Ricardo Rodrigues Ferreira
- Spine Group, Institute of Medical Assistance to the State Public Hospital Servant - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 180, São Paulo, SP, CEP: 04038-034, Brazil.,School of Medicine, University of Sao Paulo, São Paulo, SP, Brazil
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Peng YN, Tsai LC, Hsu HC, Kao CH. Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:824. [PMID: 32793669 PMCID: PMC7396236 DOI: 10.21037/atm-20-1106] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This systematic review and meta-analysis investigated differences in accuracy, operation time, and radiation exposure time between robot-assisted and freehand techniques for pedicle screw insertion. Two investigators independently searched for articles on randomized controlled trials (RCTs) published from 2012 to 2019. The final meta-analysis included seven RCTs. We compared the accuracy of pedicle screw placement, operation time, and radiation exposure time between robot-assisted and conventional freehand groups. Seven RCTs included 540 patients and placement of 2,476 pedicle screws, of which 1,220 were inserted using the robot-assisted technique and 1,256 were inserted using the conventional freehand technique. The pedicle screw positions were classified using the Gertzbein and Robbins classification (grade A-E). The combined results of Grade A [odds ratio (OR) =1.68; 95% confidence intervals (CI): 0.82-3.44; P=0.16), Grade A+B (OR =1.70; 95% CI: 0.47-6.13; P=0.42), and Grade C+D+E (OR =0.59; 95% CI: 0.16-2.12; P=0.42) for the accuracy rate revealed no significant difference between the two groups. Subgroup analysis results revealed that the TiRobot-assisted technique presented a significantly improved pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. The SpineAssist-assisted technique presented an inferior pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. No difference between the Renaissance-assisted and conventional freehand techniques was noted for pedicle screw insertion accuracy rates, based on both Grade A (OR =1.58; 95% CI: 0.85-2.96; P=0.15), Grade A+B (OR =2.20; 95% CI: 0.39-12.43; P=0.37), and Grade C+D+E (OR =0.45; 95% CI: 0.08-2.56; P=0.37) classifications. Regarding operation time, robot-assisted surgery had significantly longer operation time than conventional freehand surgery. The robot-assisted group had significantly shorter radiation exposure time. Regarding the pedicle screw insertion accuracy rate, the TiRobot-assisted technique was superior, the SpineAssist-assisted technique was inferior, and Renaissance was similar to the conventional freehand technique.
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Affiliation(s)
- Yu-Ning Peng
- Department of Medicine, China Medical University Hospital, Taichung
| | - Li-Cheng Tsai
- Department of Medicine, China Medical University Hospital, Taichung
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung
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Molliqaj G, Paun L, Nouri A, Girod PP, Schaller K, Tessitore E. Role of Robotics in Improving Surgical Outcome in Spinal Pathologies. World Neurosurg 2020; 140:664-673. [PMID: 32445895 DOI: 10.1016/j.wneu.2020.05.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The desire to improve accuracy and safety and to favor minimally invasive techniques has given rise to spinal robotic surgery, which has seen a steady increase in utilization in the past 2 decades. However, spinal surgery encompasses a large spectrum of operative techniques, and robotic surgery currently remains confined to assistance with the trajectory of pedicle screw insertion, which has been shown to be accurate and safe based on class II and III evidence. The role of robotics in improving surgical outcomes in spinal pathologies is less clear, however. METHODS This comprehensive review of the literature addresses the role of robotics in surgical outcomes in spinal pathologies with a focus on the various meta-analysis and prospective randomized trials published within the past 10 years in the field. RESULTS It appears that robotic spinal surgery might be useful for increasing accuracy and safety in spinal instrumentation and allows for a reduction in surgical time and radiation exposure for the patient, medical staff, and operator. CONCLUSION Robotic assisted surgery may thus open the door to minimally invasive surgery with greater security and confidence. In addition, the use of robotics facilitates tireless repeated movements with higher precision compared with humans. Nevertheless, it is clear that further studies are now necessary to demonstrate the role of this modern tool in cost-effectiveness and in improving clinical outcomes, such as reoperation rates for screw malpositioning.
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Affiliation(s)
- Granit Molliqaj
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
| | - Luca Paun
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Aria Nouri
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Pascal Girod
- Neurosurgical Unit, Innsbruck University Hospital, Faculty of Medicine, Innsbruck, Austria
| | - Karl Schaller
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
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Burström G, Balicki M, Patriciu A, Kyne S, Popovic A, Holthuizen R, Homan R, Skulason H, Persson O, Edström E, Elmi-Terander A. Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study. Sci Rep 2020; 10:7522. [PMID: 32371880 PMCID: PMC7200720 DOI: 10.1038/s41598-020-64462-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
The combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. The goal of this study was to examine the feasibility, accuracy and efficacy of a new robot-guided system for semi-automated, minimally invasive, pedicle screw placement. A custom robotic arm was integrated into a hybrid operating room (OR) equipped with an augmented reality surgical navigation system (ARSN). The robot was mounted on the OR-table and used to assist in placing Jamshidi needles in 113 pedicles in four cadavers. The ARSN system was used for planning screw paths and directing the robot. The robot arm autonomously aligned with the planned screw trajectory, and the surgeon inserted the Jamshidi needle into the pedicle. Accuracy measurements were performed on verification cone beam computed tomographies with the planned paths superimposed. To provide a clinical grading according to the Gertzbein scale, pedicle screw diameters were simulated on the placed Jamshidi needles. A technical accuracy at bone entry point of 0.48 ± 0.44 mm and 0.68 ± 0.58 mm was achieved in the axial and sagittal views, respectively. The corresponding angular errors were 0.94 ± 0.83° and 0.87 ± 0.82°. The accuracy was statistically superior (p < 0.001) to ARSN without robotic assistance. Simulated pedicle screw grading resulted in a clinical accuracy of 100%. This study demonstrates that the use of a semi-automated surgical robot for pedicle screw placement provides an accuracy well above what is clinically acceptable.
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Affiliation(s)
- Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
| | | | | | - Sean Kyne
- Philips Research North America, Cambridge, USA
| | | | - Ronald Holthuizen
- Department of Image Guided Therapy Systems, Philips Healthcare, Best, the Netherlands
| | - Robert Homan
- Department of Image Guided Therapy Systems, Philips Healthcare, Best, the Netherlands
| | - Halldor Skulason
- Department of Neurosurgery, Landspitali University Hospital, Reykjavik, Iceland
| | - Oscar Persson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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Yongqi L, Dehua Z, Hongzi W, Ke Z, Rui Y, Zhou F, Shaobo W, Yi L. Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial. BMC Musculoskelet Disord 2020; 21:208. [PMID: 32252725 PMCID: PMC7137259 DOI: 10.1186/s12891-020-03239-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the minimal invasiveness, safety, and accuracy of robot-assisted pedicle screw placement procedure using a modified tracer fixation device. METHODS Patients were randomly assigned to conventional fixation group (25 patients) and modified fixation group (27 patients). RESULTS No baseline statistical difference was observed between the groups (P > 0.05). The length of unnecessary incision, amount of bleeding, and fixation duration for tracer fixation respectively were 6.08 ± 1.02 mm, 1.46 ± 0.84 ml, and 1.56 ± 0.32 min in the modified fixation group and 40.28 ± 8.52 mm, 12.02 ± 2.24 ml, and 5.08 ± 1.06 min in the conventional group. The difference between both groups was significant (P < 0.05). However, no significant difference between the two groups was observed in terms of the accuracy of pedicle screw placement (P > 0.05). CONCLUSIONS The modified minimally invasive procedure for tracer fixation results in minimal trauma and is simple, reliable, and highly safe. Additionally, the procedure does not compromise the accuracy of pedicle screw placement. Thus, it has great clinical applicable value. TRIAL REGISTRATION Chinese Clinical Trial Registry: Registration number, ChiCTR1800016680; Registration Date, 15/06/2018.
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Affiliation(s)
- Li Yongqi
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China
| | - Zhang Dehua
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China
| | - Wu Hongzi
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China
| | - Zhang Ke
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China
| | - Yang Rui
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China
| | - Fang Zhou
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China
| | - Wang Shaobo
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China
| | - Liao Yi
- Department of Orthopedics, The Karamay Central Hospital, Karamay, 834000, China.
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36
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Vo CD, Jiang B, Azad TD, Crawford NR, Bydon A, Theodore N. Robotic Spine Surgery: Current State in Minimally Invasive Surgery. Global Spine J 2020; 10:34S-40S. [PMID: 32528804 PMCID: PMC7263345 DOI: 10.1177/2192568219878131] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Robotic systems in spinal surgery may offer potential benefits for both patients and surgeons. In this article, the authors explore the future prospects and current limitations of robotic systems in minimally invasive spine surgery. METHODS We describe recent developments in robotic spine surgery and minimally invasive spine surgery. Institutional review board approval was not needed. RESULTS Although robotic application in spine surgery has been gradual, the past decade has seen the arrival of several novel robotic systems for spinal procedures, suggesting the evolution of technology capable of augmenting surgical ability. CONCLUSION Spine surgery is well positioned to benefit from robotic assistance and automation. Paired with enhanced navigation technologies, robotic systems have tremendous potential to supplement the skills of spine surgeons, improving patient safety and outcomes while limiting complications and costs.
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Affiliation(s)
- Chau D. Vo
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bowen Jiang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tej D. Azad
- Stanford University School of Medicine, Stanford, CA, USA
| | - Neil R. Crawford
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Ali Bydon
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Fan M, Liu Y, He D, Han X, Zhao J, Duan F, Liu B, Tian W. Improved Accuracy of Cervical Spinal Surgery With Robot-Assisted Screw Insertion: A Prospective, Randomized, Controlled Study. Spine (Phila Pa 1976) 2020; 45:285-291. [PMID: 31568094 DOI: 10.1097/brs.0000000000003258] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, randomized, controlled trial. OBJECTIVE To compare robot-assisted and conventional implantation techniques by evaluating the accuracy and safety of implanting screws in cervical vertebrae. SUMMARY OF BACKGROUND DATA Cervical spinal surgery is difficult and dangerous as screw misplacement might lead not only to decreased stability but also neurological, vascular, and visceral injuries. A new robot-assisted surgical procedure has been introduced to improve the accuracy of implant screw positioning. METHODS We randomly assigned 135 patients with newly diagnosed cervical spinal disease and who required screw fixation using either robot-assisted or conventional fluoroscopy-assisted cervical spinal surgery. The primary outcomes were the discrepancies between the planned trajectories and the actual screw positions. RESULTS Altogether, 127 patients underwent the assigned intervention (61 robot-assisted and 66 conventional fluoroscopy-assisted). The baseline characteristics including the screw types, were similar in the two groups. Altogether, 390 screws were planed and placed in the cervical vertebrae, and 94.9% were acceptable. The robot-assisted group had a better screw placement accuracy than the conventional fluoroscopy-assisted group with associated P values <0.001 (0.83 [0.44, 1.29] vs. 1.79 [1.41, 2.50] mm). The Gertzbein and Robbins scales also showed a significant difference between the two groups (P < 0.001). Furthermore, the robot-assisted group experienced significantly less blood loss during surgery than the conventional fluoroscopy-assisted group (200 [50, 375] vs. 350 [100, 500] mL; P = 0.002) and shorter length of stay after surgery (P = 0.021). These two groups did not differ significantly regarding the duration of the operation (P = 0.525). Neurological injury occurred in one case in the conventional fluoroscopy-assisted group. CONCLUSION The accuracy and clinical outcomes of cervical spinal surgery using the robot-assisted technique tended to be superior to those with the conventional fluoroscopy-assisted technique in this prospective, randomized, controlled trial. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yajun Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Han
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jingwei Zhao
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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38
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Accuracy of Pedicle Screw Placement and Clinical Outcomes of Robot-assisted Technique Versus Conventional Freehand Technique in Spine Surgery From Nine Randomized Controlled Trials: A Meta-analysis. Spine (Phila Pa 1976) 2020; 45:E111-E119. [PMID: 31404053 DOI: 10.1097/brs.0000000000003193] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A meta-analysis. OBJECTIVE To investigate whether robot-assisted techniques are superior to conventional techniques in terms of the accuracy of pedicle screw placement and clinical indexes. SUMMARY OF BACKGROUND DATA Robot-assisted techniques are increasingly applied to spine surgery to reduce the rate of screw misplacement. However, controversy about the superiority of robot-assisted techniques over conventional freehand techniques remains. METHODS We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library for potentially eligible articles. The outcomes were evaluated in terms of risk ratio (RR) or standardized mean difference and the associated 95% confidence intervals (CIs). Meta-analysis was performed using the RevMan 5.3 software and subgroup analyses were performed based on the robot type for the accuracy of pedicle screw placement. RESULTS Nine randomized controlled trials with 696 patients were included in this meta-analysis. The results demonstrated that the robot-assisted technique was more accurate in pedicle screw placement than the freehand technique. Subgroup analyses showed that the TINAVI robot-assisted technique was more accurate in screw positions Grade A (RR, 1.10; 95% CI, 1.06-1.14), Grade B (RR, 0.46; 95% CI, 0.28-0.75), and Grades C + D + E (RR, 0.21; 95% CI, 0.09-0.45) than the freehand technique, whereas the Renaissance robot-assisted technique showed the same accuracy as the freehand technique in screw positions Grade A, Grade B, and Grades C + D + E. Furthermore, the robot-assisted techniques showed equivalent postoperative stay, visual analogue scale scores, and Oswestry disability index scores to those of the freehand technique and shorter intraoperative radiation exposure time, fewer radiation dose and proximal facet violations but longer surgical time than the freehand technique. CONCLUSION The robot-assisted technique is more accurate in pedicle screw placement than the freehand technique. And TINAVI robot-assisted pedicle screw placement is a more accurate alternative to conventional techniques and the Renaissance robot-assisted procedure. LEVEL OF EVIDENCE 1.
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39
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Tian W, Liu YJ, Liu B, He D, Wu JY, Han XG, Zhao JW, Fan MX. Guideline for Posterior Atlantoaxial Internal Fixation Assisted by Orthopaedic Surgical Robot. Orthop Surg 2020; 11:160-166. [PMID: 31025810 PMCID: PMC6594511 DOI: 10.1111/os.12454] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/19/2019] [Indexed: 12/01/2022] Open
Abstract
Atlantoaxial transarticular facet screw fixation (Magerl technique) and C1 lateral mass screws combined with C2 pedicle screws fixation (Harms technique) are the most commonly used techniques for posterior internal fixation in the upper cervical spine. Upper cervical spinal surgery is a technically demanding and challenging procedure because of complicated anatomical structures and frequent occurrence of anomalies. Accurate insertion of screws allows for stable and secure internal fixation, which is necessary for both techniques. Traditional methods under fluoroscopic assistance in this region cannot meet the requirements of high levels of accuracy and security during the procedure. Robot-assisted spinal surgery can provide accurate and reliable guidance during the screw insertion, which is evidenced in the literature. As a recently developed technique, robot-assisted surgery is supposed to be performed by skilled surgeons who have received standard training for robotic surgery. The standardized upper cervical spinal surgery assisted by the robot system needs to be introduced to these surgeons. Based on the consensus of consultant specialists, the literature review, and our local experience, this guideline included the introduction of the robotic system, the workflow of robot-assisted procedures, and the precautions to take during procedures. This guideline aims to provide a standardization of the robotic surgery for posterior atlantoaxial internal fixation.
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Affiliation(s)
- Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ya-Jun Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jing-Ye Wu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jing-Wei Zhao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ming-Xing Fan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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40
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Galetta MS, Leider JD, Divi SN, Goyal DKC, Schroeder GD. Robotics in spinal surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S165. [PMID: 31624731 DOI: 10.21037/atm.2019.07.93] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although the da Vinci robot system has garnered much attention in the realm of surgery over the past few decades, several new surgical robotic systems have been developed for spinal surgery with varying levels of robot autonomy and surgeon-specified input. These devices are currently being considered as potential avenues for increasing the precision of any surgical intervention. The following review will attempt to provide an overview of robotics in modern spine surgery and how these devices will continue to be employed in various sectors across the field.
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Affiliation(s)
- Matthew S Galetta
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph D Leider
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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41
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Spine surgical robotics: review of the current application and disadvantages for future perspectives. J Robot Surg 2019; 14:11-16. [DOI: 10.1007/s11701-019-00983-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
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42
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Spyrantis A, Cattani A, Seifert V, Freiman TM, Setzer M. Minimally invasive percutaneous robotic thoracolumbar pedicle screw implantation combined with three-dimensional fluoroscopy can reduce radiation: A cadaver and phantom study. Int J Med Robot 2019; 15:e2022. [PMID: 31216120 DOI: 10.1002/rcs.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/26/2019] [Accepted: 06/04/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Andrea Spyrantis
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
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43
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Junaid M, Afzal A, Kalsoom A, Bukhari SS. Freehand pedicle screw fixation: A safe recipe for dorsal, lumbar and sacral spine. Pak J Med Sci 2019; 35:680-684. [PMID: 31258575 PMCID: PMC6572961 DOI: 10.12669/pjms.35.3.981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine outcome of freehand pedicle screw fixation for dorsal, lumbar and sacral fractures at a tertiary care centre in the developing world. Methods: A retrospective review was performed of 150 consecutive patients who underwent pedicle screw fixation from January 1, 2012 to 31st December 2017. A total of 751 pedicle screws were placed. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of intra-operative and post-operative radiographs and/or computed tomography. Results: Among the total 751 free hand placed pedicle screws, four screws (0.53%) were repositioned due to a misdirected trajectory towards the disc space. six screws (0.79%) were identified to have cause moderate breach while four screws (0.53%) cause severe breach. There was no occurrence of iatrogenic nerve root damage or violation of the spinal canal. Conclusion: Free hand pedicle screw placement based on external landmarks showed remarkable safety and accuracy in our center. The authors conclude that assiduous adherence to technique and preoperative planning is vital to success.
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Affiliation(s)
- Muhammad Junaid
- Dr. Muhammad Junaid, FCPS IFAANS, Department of Neurosurgery, PNS Shifa Hospital, Karachi, Pakistan
| | - Ali Afzal
- Dr. Ali Afzal, FCPS, Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Anisa Kalsoom
- Dr. Anisa Kalsoom, FCPS, Department of Radiology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Syed Sarmad Bukhari
- Dr. Syed Sarmad Bukhari, MBBS, Department of Neurological Surgery, Aga Khan University Hospital, Karachi, Pakistan
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44
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Sayari AJ, Pardo C, Basques BA, Colman MW. Review of robotic-assisted surgery: what the future looks like through a spine oncology lens. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:224. [PMID: 31297389 DOI: 10.21037/atm.2019.04.69] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent advancements in medical technology have led to the emergence of robotic-assisted surgery with the hope of creating a safer and more efficient surgical environment for the patient and surgical team. Spine surgery and spine tumor surgery involve challenging anatomy and demand highly precise surgical maneuvers, creating an important niche for robotic systems. While still in its infancy, robotics in spine surgery have proven successful in pedicle screw placement. Similarly, robotics has begun to be used for accurate resections and surgical planning in tumor surgery. As future studies are published and robotics systems continue to evolve, we can expect more tactile haptic feedback and implementation of useful instruments to improve preoperative planning, resection guidance, and reconstruction during spine tumor surgery.
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Affiliation(s)
- Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Coralie Pardo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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45
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Molina CA, Theodore N, Ahmed AK, Westbroek EM, Mirovsky Y, Harel R, Orru' E, Khan M, Witham T, Sciubba DM. Augmented reality-assisted pedicle screw insertion: a cadaveric proof-of-concept study. J Neurosurg Spine 2019; 31:139-146. [PMID: 30925479 DOI: 10.3171/2018.12.spine181142] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/21/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Augmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator's retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods. METHODS Five cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures. RESULTS The overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded "excellent" usability classification. CONCLUSIONS AR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.
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Affiliation(s)
| | | | | | | | - Yigal Mirovsky
- 2Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zefirin; and
| | - Ran Harel
- 3Department of Neurosurgery, Sheba Medical Center, affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Emanuele Orru'
- 4Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Majid Khan
- 4Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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46
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Perdomo-Pantoja A, Ishida W, Zygourakis C, Holmes C, Iyer RR, Cottrill E, Theodore N, Witham TF, Lo SFL. Accuracy of Current Techniques for Placement of Pedicle Screws in the Spine: A Comprehensive Systematic Review and Meta-Analysis of 51,161 Screws. World Neurosurg 2019; 126:664-678.e3. [PMID: 30880208 DOI: 10.1016/j.wneu.2019.02.217] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation-guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement. METHODS A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses. RESULTS Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5%, 93.1%, 91.5%, and 90.5%, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH. CONCLUSIONS The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.
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Affiliation(s)
| | - Wataru Ishida
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Holmes
- Florida A&M University-Florida State University College of Engineering, Tallahassee, Florida, USA
| | - Rajiv R Iyer
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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47
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Han X, Tian W, Liu Y, Liu B, He D, Sun Y, Han X, Fan M, Zhao J, Xu Y, Zhang Q. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine 2019; 30:615-622. [PMID: 30738398 DOI: 10.3171/2018.10.spine18487] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery. METHODS Patients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure. RESULTS A total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01). CONCLUSIONS TiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov).
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Affiliation(s)
- Xiaoguang Han
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Wei Tian
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Yajun Liu
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Bo Liu
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Da He
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Yuqing Sun
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Xiao Han
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Mingxing Fan
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Jingwei Zhao
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Yunfeng Xu
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
| | - Qi Zhang
- 1Department of Spine Surgery, Beijing Jishuitan Hospital; and
- 2Beijing Key Laboratory of Robotic Orthopaedics, Beijing, People's Republic of China
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Fischer CR, Beaubrun B, Manning J, Qureshi S, Uribe J. Evidence Based Medicine Review of Posterior Thoracolumbar Minimally Invasive Technology. Int J Spine Surg 2019; 12:680-688. [PMID: 30619671 DOI: 10.14444/5085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Evaluate the current evidence in meta-analyses on posterior thoracolumbar minimally invasive surgery techniques and outcomes for degenerative conditions. Methods A systematic review of the literature from 1950 to 2015. Results The review of the literature yielded 34 meta-analysis studies evaluating posterior thoracolumbar minimally invasive techniques and outcomes for degenerative conditions. There were 11 studies included which investigated minimally invasive surgery (MIS) versus open posterior lumbar decompressions. There were 14 studies included which investigated MIS versus open posterior lumbar interbody fusions. Finally, there were 9 studies focused on navigation techniques and radiation safety within MIS procedures. Conclusions There are 34 meta-analysis studies evaluating minimally invasive to open thoracolumbar surgery for degenerative disease. The studies show a trend toward decreased estimated blood loss, decreased length of stay, decreased complications, similar fusion rates, improved accuracy, and decreased radiation when minimally invasive techniques are used.
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Affiliation(s)
| | | | | | | | - Juan Uribe
- University of South Florida, Tampa, Florida
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE The authors aim to review comparative outcome measures between robotic and free-hand spine surgical procedures including: accuracy of spinal instrumentation, radiation exposure, operative time, hospital stay, and complication rates. SUMMARY OF BACKGROUND DATA Misplacement of pedicle screws in conventional open as well as minimally invasive surgical procedures has prompted the need for innovation and allowed the emergence of robotics in spine surgery. Before incorporation of robotic surgery in routine practice, demonstration of improved instrumentation accuracy, operative efficiency, and patient safety are required. METHODS A systematic search of the PubMed, OVID-MEDLINE, and Cochrane databases was performed for articles relevant to robotic assistance of pedicle screw placement. Inclusion criteria were constituted by English written randomized control trials, prospective and retrospective cohort studies involving robotic instrumentation in the spine. Following abstract, title, and full-text review, 32 articles were selected for study inclusion. RESULTS Intrapedicular accuracy in screw placement and subsequent complications were at least comparable if not superior in the robotic surgery cohort. There is evidence supporting that total operative time is prolonged in robot-assisted surgery compared to conventional free-hand. Radiation exposure appeared to be variable between studies; radiation time did decrease in the robot arm as the total number of robotic cases ascended, suggesting a learning curve effect. Multilevel procedures appeared to tend toward earlier discharge in patients undergoing robotic spine surgery. CONCLUSION The implementation of robotic technology for pedicle screw placement yields an acceptable level of accuracy on a highly consistent basis. Surgeons should remain vigilant about confirmation of robotic-assisted screw trajectory, as drilling pathways have been shown to be altered by soft tissue pressures, forceful surgical application, and bony surface skiving. However, the effective consequence of robot-assistance on radiation exposure, length of stay, and operative time remains unclear and requires meticulous examination in future studies. LEVEL OF EVIDENCE 4.
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Tan LA, Yerneni K, Tuchman A, Li XJ, Cerpa M, Lehman RA, Lenke LG. Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction. JOURNAL OF SPINE SURGERY 2018; 4:319-327. [PMID: 30069524 DOI: 10.21037/jss.2018.05.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We aim to demonstrate the safety and efficacy of utilizing 3D-printed spine models to facilitate freehand pedicle screw placement in complex spinal deformity correction. Currently there is no data on using 3D-printed models for freehand pedicle screw placement spinal deformity correction. Methods All patients undergoing spinal deformity correction over a 16-month period (September 2015 - December 2016) at the Spine Hospital of Columbia University Medical Center by the senior surgeon were reviewed. 3D-printed spine models were used to facilitate intraoperative freehand pedicle screw placement in patients with severe spinal deformities. Intraoperative O-arm imaging was obtained after pedicle screw placement in all patients. Screws were graded as intrapedicular, <2 mm breach, 2-4 mm breach, and >4 mm breach; anterior breaches >4 mm were also recorded. Screw accuracy was compared to a historical cohort (not using 3D-printed models) using SPSS 23.0 (Chicago, IL, USA). Results A total of 513 freehand pedicle screws were placed from T1 to S1 in 23 patients. Overall, 494 screws (96.3%) were placed in acceptable positions according to the pre-operative plan, which had no statistically significant difference (P=0.99) compared to a historical cohort with less severe deformities. There were 84.2% screw that were intrapedicular or <2 mm breach; among the 81 screws (15.8%) with >2 mm breach, 67 were lateral breaches (most are intended juxtapedicular placement), whereas 14 were medial breaches. There were 11 screws (2.1%) that required repositioning due to pedicle violation, and eight screws (1.6%) had >4 mm anterior breach and required shortening. There was no neuromonitoring change or any other complications directly or indirectly related to freehand pedicle screw placement. Conclusions The 3D-printed spinal model can make freehand pedicle screw placement safer in severe spinal deformity cases with acceptable accuracy, and no neurological or vascular complications.
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Affiliation(s)
- Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Ketan Yerneni
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Alexander Tuchman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Xudong J Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Meghan Cerpa
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
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